Efectos de la rehabilitación temprana en el paciente adulto en condición crítica: una revisión narrativa

Javier López-Yarce; Obed Solis Martínez; Ruben Antonio Vázquez-Roque

doi:10.35454/rncm.v6n2.505

Authors

Javier López-Yarce Universidad Popular Autónoma del Estado de Puebla
Obed Solis Martínez Universidad Popular Autónoma del Estado de Puebla
Ruben Antonio Vázquez-Roque Meritorious Autonomous University of Puebla https://orcid.org/0000-0002-2712-5714

DOI:

https://doi.org/10.35454/rncm.v6n2.505

Keywords:

Critical care, Physiotherapy, Critical illness, Rehabilitation, Early rehabilitation, Intensive care unit, Muscle wasting, Muscle weakness, Exercise

Abstract

The physical inactivity of the patient during a long hospital stay contributes to the loss of muscle mass, mainly in the lower extremities, which in turn generates complications and prolonged hospital stays. The catabolic state during critical illness causes a role reversal in muscle. Per day, in the intensive care unit (ICU) there is a 2% loss of muscle mass, and during the first week of hospital stay there is a 12.5% loss of muscle cross-sectional area in the presence of mechanical ventilation (MV). ICU-acquired weakness (ICU-AW) is a condition of generalized weakness that occurs during critical illness in up to 50% of patients. ICU-AW is mainly related to hospital bed immobilization, longer duration of MV, increased hospital stay accompanied by a reduction in skeletal muscle mass, as well as increased mortality. In the ICU, the main indicator to be evaluated in the patient is muscle weakness. The aim of this review was to describe the effects of prolonged stay and bed rest in critically ill patients, as well as the importance of early rehabilitation. According to the results, early rehabilitation based on progressive mobility in the ICU is a priority and is aimed at preventing musculoskeletal deterioration and favoring physical recovery. In addition, it reduces ICU stay, decreases MV days, improves quality of life and decreases mortality.

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References

Uster A, Ruehlin M, Mey S, Gisi D, Knols R, Imoberdorf R, et al. Effects of nutrition and physical exercise intervention in palliative cancer patients: A randomized controlled trial. Clin Nutr. 2018;37(4):1202-1209. doi: 10.1016/j.clnu.2017.05.027

Wandrag L, Brett SJ, Frost GS, Bountziouka V, Hickson M. Exploration of muscle loss and metabolic state during prolonged critical illness: Implications for intervention?. PLoS One. 2019;14(11):e0224565. doi: 10.1371/journal.pone.0224565

Gropper S, Hunt D, Chapa DW. Sarcopenia and Psychosocial Variables in Patients in Intensive Care Units: The Role of Nutrition and Rehabilitation in Prevention and Treatment. Crit Care Nurs Clin North Am. 2019;31(4):489-499. doi: 10.1016/j.cnc.2019.07.004

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: 10.1093/ageing/afy169

Hashem MD, Nelliot A, Needham DM. Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future. Respir Care. 2016;61(7):971-979. doi: 10.4187/respcare.04741

Wischmeyer PE, Puthucheary Z, San Millán I, Butz D, Grocott MPW. Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise. Curr Opin Crit Care. 2017;23(4):269-278. doi: 10.1097/MCC.0000000000000431

Puthucheary ZA, Astin R, Mcphail MJW, Saeed S, Pasha Y, Bear DE, et al. Metabolic phenotype of skeletal muscle in early critical illness. Thorax. 2018;73(10):926-935. doi: 10.1136/thoraxjnl-2017-211073

Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. J Physiother. 2017;63(1):4-10. doi: 10.1016/j.jphys.2016.10.011

Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015;61(3):125-134. doi: 10.1016/j.jphys.2015.05.016

Alam MJ, Roy S, Iktidar MA, Padma FK, Nipun KI, Chowdhury S, et al. Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index. Acute Crit Care. 2022;37(1):94-100. doi: 10.4266/acc.2021.01354

Thille AW, Boissier F, Muller M, Levrat A, Bourdin G, Rosselli S, et al. Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation. Crit Care. 2020;24(1):86. doi: 10.1186/s13054-020-2807-9

Ndahimana D, Kim EK. Energy Requirements in Critically Ill Patients. Clin Nutr Res. 2018;7(2):81-90. doi: 10.7762/cnr.2018.7.2.81

Borges RC, Soriano FG. Association Between Muscle Wasting and Muscle Strength in Patients Who Developed Severe Sepsis And Septic Shock. Shock. 2019;51(3):312-320. doi: 10.1097/SHK.0000000000001183

Veldema J, Bösl K, Kugler P, Ponfick M, Gdynia HJ, Nowak DA. Cycle ergometer training vs resistance training in ICU-acquired weakness. Acta Neurol Scand. 2019;140(1):62-71. doi: 10.1111/ane.13102

Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018;3(3):CD010754. doi: 10.1002/14651858.CD010754.pub2

Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;43(2):171-183. doi: 10.1007/s00134-016-4612-0

Eggmann S, Luder G, Verra ML, Irincheeva I, Bastiaenen CHG, Jakob SM. Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial. PLoS One. 2020;15(3):e0229725. doi: 10.1371/journal.pone.0229725

McWilliams D, Jones C, Atkins G, Hodson J, Whitehouse T, Veenith T, et al. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial. J Crit Care. 2018;44:407-412. doi: 10.1016/j.jcrc.2018.01.001

Voiriot G, Oualha M, Pierre A, Salmon-Gandonnière C, Gaudet A, Jouan Y, et al. Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges. Ann Intensive Care. 2022;12(1):58. doi: 10.1186/s13613-022-01038-0

de Azevedo JRA, Lima HCM, Frota PHDB, Nogueira IROM, de Souza SC, Fernandes EAA, et al. High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes. BMC Anesthesiol. 2021;21(1):283. doi: 10.1186/s12871-021-01492-6

Wright SE, Thomas K, Watson G, Baker C, Bryant A, Chadwick TJ, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018;73(3):213-221. doi: 10.1136/thoraxjnl-2016-209858

Schujmann DS, Teixeira Gomes T, Lunardi AC, Lamano MZ, Fragoso A, Pimentel M, et al. Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial. Crit Care Med. 2020;48(4):491-497. doi: 10.1097/CCM.0000000000004181

Barbalho M, Rocha AC, Seus TL, Raiol R, Del Vecchio FB, Coswig VS. Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial. Clin Rehabil. 2019;33(2):233-240. doi: 10.1177/0269215518801440

Schaller SJ, Scheffenbichler FT, Bose S, Mazwi M, Deng H, Krebs F, et al. Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis. Intensive Care Med. 2019;45(2):201-210. doi: 10.1007/s00134-019-05528-x

Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD,Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377-1388. doi: 10.1016/S0140-6736(16)31637-3

Karadas C, Ozdemir L. The effect of range of motion exercises on delirium prevention among patients aged 65 and over in intensive care units. Geriatr Nurs. 2016;37(3):180-185. doi: 10.1016/j.gerinurse.2015.12.003

Kho ME, Molloy AJ, Clarke FJ, Reid JC, Herridge MS, Karachi T, et al. Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients. BMJ Open Respir Res. 2019;6(1):e000383. doi: 10.1136/bmjresp-2018-000383

Kho ME, Molloy AJ, Clarke FJ, Ajami D, McCaughan M, Obrovac K, et al. TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients. PLoS One. 2016;11(12):e0167561. doi: 10.1371/journal.pone.0167561

Maffei P, Wiramus S, Bensoussan L, Bienvenu L, Haddad E, Morange S, et al. Intensive Early Rehabilitation in the Intensive Care Unit for Liver Transplant Recipients: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2017;98(8):1518-1525. doi: 10.1016/j.apmr.2017.01.028

Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, et al. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med. 2016;44(6):1145-1152. doi: 10.1097/CCM.0000000000001643

Pang Y, Li H, Zhao L, Zhang C. An Established Early Rehabilitation Therapy Demonstrating Higher Efficacy and Safety for Care of Intensive Care Unit Patients. Med Sci Monit. 2019;25:7052-7058. doi: 10.12659/MSM.916210

Eggmann S, Verra ML, Luder G, Takala J, Jakob SM. Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial. PLoS One. 2018;13(11):e0207428. doi: 10.1371/journal.pone.0207428

Windmöller P, Bodnar ET, Casagrande J, Dallazen F, Schneider J, Berwanger SA, et al. Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical Myocardial Revascularization: A Randomized Clinical Trial. Respir Care. 2020;65(2):150-157. doi: 10.4187/respcare.06919

Liu D, Xu Z, Qu C, Huo B. [Efficacy and safety of early physical therapy for acute gastrointestinal injury during mechanical ventilation in patients with sepsis: a randomized controlled pilot trial]. Nan Fang Yi Ke Da Xue Xue Bao. 2019;39(11):1298-1304. doi: 10.12122/j.issn.1673-4254.2019.11.06

Sarfati C, Moore A, Pilorge C, Amaru P, Medialdua P, Rodet E, et al. Efficacy of early passive tilting in minimizing ICU-acquired weakness: A randomized controlled trial. J Crit Care. 2018;46:37-43. doi: 10.1016/j.jcrc.2018.03.031

Fossat G, Baudin F, Courtes L, Bobet S, Dupont A, Bretagnol A, et al. Effect of In-Bed Leg Cycling and Electrical Stimulation of the Quadriceps on Global Muscle Strength in Critically Ill Adults: A Randomized Clinical Trial. JAMA. 2018;320(4):368-378. doi: 10.1001/jama.2018.9592

Chen YH, Hsiao HF, Li LF, Chen NH, Huang CC. Effects of Electrical Muscle Stimulation in Subjects Undergoing Prolonged Mechanical Ventilation. Respir Care. 2019;64(3):262-271. doi: 10.4187/respcare.05921

Ferrie S, Allman-Farinelli M, Daley M, Smith K. Protein Requirements in the Critically Ill: A Randomized Controlled Trial Using Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2016;40(6):795-805. doi: 10.1177/0148607115618449

Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil. 2015;29(11):1051-1063. doi: 10.1177/0269215514567156